By Michael N. Brown, Fellow Health Partners
Each fall, open enrollment season arrives—a period filled with both optimism and apprehension. Americans sift through health-plan options, weighing cost against coverage in an effort to find something that fits their needs and their budget. But with each passing year, the balancing act becomes more difficult.
Premiums, deductibles, copays, and coinsurance continue to rise—whether through Affordable Care Act (ACA) plans or employer-based insurance. The typical U.S. household now spends roughly 10 % of its annual income1 (and in many states more than 10 %) on premiums and deductibles alone. That’s not just a financial strain—it’s a growing barrier to care.
And while patients feel that pressure first, healthcare providers quickly feel it too. Behind the scenes, practices are struggling with unpaid patient balances, delayed payments, and shrinking margins, as the financial burden increasingly shifts from insurers to individuals.
When Rising Healthcare Costs Hit the Exam Room
Behind every insurance card is a patient who’s being asked to pay more out of pocket. Even those with solid employer coverage face higher deductibles and narrower networks.
For patients, that means confusion and stress. For providers, it often means revenue instability and administrative overload.
When patients can’t pay their share, providers end up chasing balances on the back end—sending multiple statements, making repeated phone calls, and too often, ultimately writing off what remains uncollectible.
The consequences ripple through the practice:
- Staff spend more hours on billing and collections.
- Administrative costs rise as cash flow slows.
- Physicians lose valuable time to financial concerns rather than patient care.
It’s an unsustainable model—one that turns financial stress into burnout and lost revenue across the healthcare ecosystem.
The Affordability Gap: Insured, But Not Protected
The Affordable Care Act expanded coverage but didn’t necessarily make care affordable. Rising deductibles and coinsurance have created a new class of “underinsured” patients—people who technically have coverage but can’t afford to use it.
The result is predictable but damaging: deferred care, surprise bills, and unpaid balances that force providers to operate as lenders. Smaller and midsized practices are hit hardest, as limited margins make every dollar of patient responsibility matter.
Traditional revenue cycle processes were never built for this environment of high patient cost-sharing. The time has come for a new approach—one built on revenue integrity.
Revenue Integrity: A Smarter Way Forward
While no practice can control national insurance trends, providers can control how they manage financial workflows and patient engagement. The answer lies in a revenue integrity strategy—one that unites clinical accuracy, operational efficiency, and transparent communication.
At Fellow Health Partners, we’ve seen firsthand how a thoughtful approach to revenue cycle management (RCM) not only strengthens financial performance but also improves patient satisfaction and trust.
Here’s how to make that happen:
- Enhance Financial Transparency
Patients are far more likely to pay when they understand their responsibilities upfront. Clear pre-visit cost estimates, transparent pricing, and digital payment tools build confidence and reduce confusion.
Practices should also ensure that financial policies are clearly stated in intake paperwork and that patients are aware of them before treatment begins.
- Engage Patients Early
The earlier the financial conversation starts, the better the outcome. Collecting partial payments when appropriate or setting up structured payment plans at the time of service dramatically improves collection rates.
It’s equally important that staff are trained and confident in communicating these policies. Empathy and clarity turn potentially uncomfortable conversations into moments of trust and partnership.
- Leverage Data, Automation, and AI
Modern revenue cycle technologynow includes predictive analytics and automation tools that flag potential payment issues before they happen. AI-driven systems can forecast patient payment behavior, automate follow-up reminders, and even detect coding errors or claim denials before submission.
By embracing these technologies, practices can reduce manual effort, identify risk earlier, and keep the patient experience positive and streamlined.
- Align People, Process, and Technology
Revenue integrity depends on alignment—between clinical documentation, coding, billing, and patient communication. When people, process, and technology work together, errors drop, collections rise, and patients feel better cared for from both a clinical and financial perspective.
Why This Matters Now
As open enrollment season unfolds, patients are making decisions that will define their care and their costs for the next year. For providers, this is the perfect time to evaluate how they engage patients, bill for services, and manage revenue.
Practices that strengthen their revenue cycle management today will be far better prepared to handle tomorrow’s financial and regulatory shifts.
The connection is simple but profound: a healthy revenue cycle supports a healthy practice. And a financially stable practice is better positioned to invest in staff, technology, and, most importantly, patient care.
From Crisis to Opportunity
It’s easy to view rising healthcare costs as an unavoidable burden. But forward-thinking providers are reframing the challenge. By combining empathy with operational discipline, they’re transforming financial strain into stronger patient relationships and long-term sustainability.
At Fellow Health Partners, we see this not as a crisis but as an opportunity—to educate, engage, and evolve.
The future of healthcare depends not only on who gets coverage, but on whether care remains both accessible and sustainable. Achieving that balance requires financial systems that work as hard—and as intelligently—as the people who deliver the care itself.
References
Collins S, Springsteen M, Glied S. State Trends in Employer Premiums and Deductibles, 2010-2020. The Commonwealth Fund; Jan 2022. “Premium contributions and deductibles in employer health plans accounted for 11.6 % of median household income in 2020.” Commonwealth Fund+1
